Fournier Pauline, Fourcade Joelle, Roncalli Jérome, Salvayre Robert, Galinier Michel, Caussé Elizabeth
Clin Lab. 2015;61(9):1137-45. doi: 10.7754/clin.lab.2015.141238.
Hyperhomocysteinemia (HHcy) is a risk factor for cardiovascular disease. Homocysteine (Hcy) can generate reactive oxygen species. Oxidative stress enhances the progression of cardiovascular diseases and has long been implicated in chronic heart failure (CHF). This study was to evaluate the predictive value of plasma Hcy levels in CHF patients and to investigate the relationship with other markers.
We investigated 134 adult CHF patients (males, 74%; mean age, 60.0 ± 14.8 years). Echocardiography, 6-min walk test, and determination of peak oxygen consumption (VO(2max)) were performed. Serum levels of Hcy and other markers were determined. Clinical follow-up was performed at five years.
The mean Hcy level was markedly elevated in CHF patients (18.4 ± 7.83 μmol/L) vs. control subjects (12.8 ± 3.14 μmol/L; p < 0.01), whatever the etiology of heart failure (non-ischemic, n = 74, 17.6 ± 7.8 μmol/L; ischemic, n = 60, 19.3 ± 7.8 μmol/L). Hcy correlated negatively with VO(2max) and positively with BNP. Kaplan-Meier analysis showed that CHF patients with HHcy > 15 μmol/L had a significantly lower survival rate (35% vs. 56%, log-rank p < 0.05) than those without HHcy. Cox regression revealed that HHcy and hs-CRP were the most powerful independent predictors of mortality in patients at 5 years.
HHcy is common in CHF patients and is associated with an increased risk of death at 5 years. We suggest that Hcy can be used in clinical practice as an additional risk marker in CHF patients with various medications.
高同型半胱氨酸血症（HHcy）是心血管疾病的一个危险因素。同型半胱氨酸（Hcy）可产生活性氧。氧化应激会加速心血管疾病的进展，长期以来一直被认为与慢性心力衰竭（CHF）有关。本研究旨在评估血浆Hcy水平对CHF患者的预测价值，并探讨其与其他标志物的关系。
我们调查了134例成年CHF患者（男性占74%；平均年龄60.0±14.8岁）。进行了超声心动图、6分钟步行试验以及峰值耗氧量（VO₂max）测定。测定了血清Hcy水平和其他标志物。进行了为期五年的临床随访。
无论心力衰竭的病因如何（非缺血性，n = 74，17.6±7.8 μmol/L；缺血性，n = 60，19.3±7.8 μmol/L），CHF患者的平均Hcy水平（18.4±7.83 μmol/L）均显著高于对照组（12.8±3.14 μmol/L；p < 0.01）。Hcy与VO₂max呈负相关，与脑钠肽（BNP）呈正相关。Kaplan-Meier分析显示，HHcy>15 μmol/L的CHF患者的生存率（35%对56%，对数秩检验p < 0.05）显著低于无HHcy的患者。Cox回归显示，HHcy和超敏C反应蛋白（hs-CRP）是患者五年死亡率最有力的独立预测因素。
HHcy在CHF患者中很常见，并且与五年死亡风险增加相关。我们建议，在临床实践中，Hcy可作为接受各种药物治疗的CHF患者的额外风险标志物。
